Last week I talked about an oft-overlooked healthcare industry: the Employer Wellness industry. Check out that post here
This week I'll speak to Rick McCartney, the CEO of an employer wellness company called iRewardHealth, that's using digital technology and behavioral science to help people stay healthy.
Zach: Hi Rick! Great to talk to you - Do you mind giving the Sparknotes version of how you got into Employer Wellness?
Rick: “Sure - I am a nurse practitioner and was trained in behavioral health. I was working in Psychiatry on lifestyle interventions and noticed a major issue that when people had mental health issues, it was so hard to treat them because their lifestyle was such a roadblock. So I realized that really getting people to sleep better, be less stressed, and be more active was an important step to improving their health and I see that true across many medical specialties.
So, three and a half years ago I started iRewardHealth as an effort to scale lifestyle intervention technology and to use the right type of tools and reinforcement to help people build habits. In the beginning we focused on the clinical setting and what the research supports and how that translates to the mobile setting, and for the past two years we’ve had a running product and full-time staff.”
Zach: How do employers typically approach wellness?
Rick: “It’s really split - there are some that think all health care will come from 3rd party companies and there are some that think that any health initiatives have to come intentionally from the top leadership. The first buy a bundle and passively distribute benefits without much focus, but the ones who do wellness best are the second: those that make a company-wide effort and create a culture of health. That’s where outcomes come from.”
Zach: How does employer wellness and wellness data fit into traditional primary care?
Rick: “Well there’s a move for dentistry and eye clinics and other screenings to actually come to employers, bringing the clinic to the office. But, there’s a lot that doctor’s offices aren’t doing.
There’s all types of data being created like step counts and that isn’t being included in patient notes but might be valuable. But there’s really no motivation for clinicians to integrate that now. They try to cure diseases and avoid risk, and if you make a decision based off a step count you could be opening yourself up to trouble should the patient have problems down the road. Clinics are playing defense all the time. Also, there aren’t easy ways to pipe user data into the EHR because they’re so fragmented. If a data warehousing service like Health Catalyst wanted to make it happen they probably could, but a clinic individually will have trouble leveraging user data.”
Zach: Why don’t insurance companies or HMO’s invest more into wellness?
Rick: “They actually are to some extent. But insurance companies still have to pay a specific percentage of their revenue on claims. Also, as awful as it sounds, insurance companies have very little incentive to think about patient wellbeing ten years down the road. They’ll be answering to their investors next quarter and while patients can move between insurance companies every year, that incentive just isn’t there. To really get a payor leveraging wellness I think public insurance will have to step up. Medicare or Medicaid will have to make the decision to be industry leaders and prioritize preventative health. But for now insurance companies pay providers like a fire department. A fire springs up: the flu, cancer, diabetes, and they try to put it out but don’t pay for fire prevention.”
Zach: What is really working in employer wellness?
Rick: “One of the best ways to show success is to show 5% weight loss and sustain that for six months, or ideally a year. There’s really good research that shows if you sustain that loss for a year there will be long term health benefits. But, a lot of the things that are most asked for by employers aren’t effective. Social media is huge in wellness but it doesn’t work. And you can empathize with why it doesn’t work. The young, 25-year old marathoner will love to post their steps online, but someone who is obese and is struggling to lose 15 pounds doesn’t want to use social media in that way. They’re spending so much time trying to take their pictures carefully when they’re posting online, they're certainly not going to be sharing their weight. Stress management - that’s way harder to effectively offer, but it is certainly being asked for..
" For now insurance companies pay providers like a fire department. A fire springs up: the flu, cancer, diabetes, and they try to put it out but don’t pay for fire prevention. "
Zach: What’s getting users engaged?
Rick: “Yeah, I think a lot of people are really get this wrong. The first is you really need people logging on to your service: if it’s too complicated they’re not going to get there. I’m not totally down on tutorials but I like the line ‘If your app needs a tutorial, it’s too complex’. If it’s not usable, no amounts of other features will redeem it. We pride ourselves on being experts in UX. The second is that the experience has to be reinforcing. If you want an action to happen again - going for a jog or eating well, it has to be reinforced. It can be intrinsic motivation: the action brings personal value, then there is already value and you don’t need to touch it.
The other way it’s reinforced is extrinsically, maybe with information, incentive, or something linked with behavior to make you feel good. And these are different for everyone. You generally want a reinforcer that’s generalizable and everyone can use it, like food, shelter, sex, vacation time, or money. The most important part of inducing extrinsic motivation is variation, variable reinforcement is important because predictable systems get boring. But intrinsic motivation is more sustainable and so you can use extrinsic motivation as a hook but eventually transitioning to values so that the these reinforcers are more intrinsic.”
You can learn more about Rick and his work at irewardhealth.com
Up Next: An interview with Farzad Mostashari
Farzad Mostashari is the CEO of Aledade, an ACO management company with almost $100 million in funding. He'll talk about everything from working in the NYC Health department to the future of home care.